2 We want to save minutes to taking important decisionsWe want to save timeWe want to save minutes to taking important decisionsbutwhere is the correct decision pointemergency roomCICUon sceneat homeat the dispatching center

3 There is not a single triage point but a succession of different points of triageto achieve a successful reperfusionstrategy

11 The good elements of decision = clinic + risk factor assessmentpain characteristicspersonal and family historycardiac historyagerisk factorscurrent treatmentin case of any doubtsend the most competent team

16 Staffing and equipping emergency medical services systems.Rapid identification and treatment of AMINational heart attack alert program coordinating committeeAm J Emerg med 1995;13:58-86Pre-hospital identification of patients with AMI by 12-lead ECG using cellular telephone transmission has decreased the time to treatment; its use should be encouraged. Development and strategies for transmitting the 12-lead ECG from the field to the ED should be encouraged.

18 Telemedicine and decision support in emergency ambulances in UPPSALA The GPS help the EMD in assigning the closest available resource to a casea 12-lead ECG is transmitted to the CICU for consultationPHT is performed by GP on sceneTelemedicine and decision support in emergency ambulances in UPPSALAFrom R. Karlsten and BA Sjöquvist Journal of telemedicine and telecare 2000;6: 1-7

19 What is Behind Medical ValidationTransmission of the ECG by modem rather than by faxSending in all data on the patient simultaneously (PDA)Storing ECG in a precious data bankWho to receive ?

20 EASY !!The doctor must be available 24 h / 24 h for analysis and validation on linedispatching centerdoctor ERCICUTransmission must not be an indirect factor prolonging the delay to reperfusion

33 Key Issue: Regional Development of Cardiology DepartmentsThe best chance for the patient, depends on:timelocationpossibilities

34 The patient MUST arrive directly at the Cardiac Intensive Care UnitPassing through the ER means losing time, losing myocardiumThat’s again one of the SAMU functions:Finding the best place for the patient:SHORT TRACK